On Monday, 10/15/2012, I had the honor and the pleasure of meeting and learning from the incomparable Penny Simkin. She happened to be in town for a conference and took some time out of her busy schedule to meet with a small group of doulas, childbirth educators and midwives at a local Panera. (note to self: Coffee at 7:00pm means no sleep till after midnight!)
Over the course of the evening I jotted down some notes. Here they are in a somewhat readable format:
Penny, as a Physical Therapist back in 1968 (I was negative 8 years old), wanted to learn how to help a woman in labor. Turns out, PT is a great tool for helping laboring women. Did you know, the first Lamaze instructors were all PT’s? Yoga is a good fit for this role as well. As a body-worker, I can see the pregnant mother’s body through a different lens and better understand her physical pain. I’m much less hands on than a PT, but I still help women work muscles they are not familiar with. I also use a good number of Penny’s tricks in my Confident Birthing classes. (enough about me… back to Penny!)
“Always ask a woman to write her birth story. 15-20 years later the woman will remember accurately her satisfaction level with her birth. About ½ of all women will have the highest level of satisfaction. The rest will have a low or very low level of satisfaction.”
Words that are said matter. These words come from doctors, midwives, nurses, etc.
“We can’t control labor, but we can control how we care for women.”
All women don’t have great births. If a woman has had a traumatic birth, ask her “would you like to talk about it?” A traumatic birth is abuse, assault, rape, etc.
Sexual abuse can have an impact on adult life and on pregnancy and birth.
For the subsequent birth after a traumatic one: Good therapy, counseling and support will help a woman go from Trauma to Triumph!
It is PTSD or something else? Some women will ‘stuff’ the birth experience, at least until she’s pregnant again. So, you address the 1st birth, by addressing the current pregnancy.
Self Assessment of Maternal Distress After Childbirth (SAMDAC) is a form women can fill out to help determine where they are emotionally after a challenging birth.
Ask women to say “I want and need _______.” It helps them articulate how to make this birth better than their last birth.
Have them write their birth story.
“If this same thing happens again with this new pregnancy, how will you handle it differently?” This gives mom a sense of control. “How can you change the situation?” “What’s your biggest fear? How do you deal with it?”
Penny “loves the controversy” surrounding birth. She’s a proponent of normal, physiologic birth (and so am I). There is so much working against normal birth. She works study and promote physiologic birth.
“How do we affect change with regards to birth in America?”
In the 1960’s there was a consumer (mom) movement to change the way women gave birth. The homebirth movement was a key factor.
Middle class women were the influential consumers. (I believe we still are.) The hospitals responded with birthing rooms with a more home-like environment. It was just enough to quell the movement and quiet the outcry. Women were placated with the trappings of a normal physiologic birth, but not given the change in the medical procedures they deserved.
1975-1985 were great years for birth. Women had husbands in the delivery room and routine enemas were eliminated. However, with the rise of the epidural, everything took a big step back.
Childbirth educators were good for change. That is, until they got co-opted by the hospitals. The hospitals tied their hands and limited what they could teach. So, best practices were not conveyed to these mothers.
I’d like to dig up more research. Penny isn’t the only one who feels this way. I do too, and so do many other influential birth professionals. There is more information here: Childbirth Education in the 21st Century: An Immodest Proposal
Thus the consumer movement faded. The c-section rate went up, induction rate went up, epidural rate went up, etc. This is where we are today.
My question to Penny: “How can we explain to women, tactfully, that their doctor isn’t following best practices in cases like routine IV fluids, etc., without undermining the woman’s trust in her care provider?”
“You can’t persuade her with facts.” That threw me for a loop. You must respect her doctor first. Then ask her “how do you feel about that?” “Your doctor wants you to be well informed.” Appeal to her on a personal level, from the position of compassion.
When talking to the doctor, the mother should talk from an emotional position, a personal position. “Please can you support me? Can you help me to have (not to have) thus and such?”
On birth plans: The nurse should compliment mom on a detailed and long birth plan and help her work on it so that it is reasonable and manageable.
“How can we help women before they become pregnant?” We start through high school or college classes.
Ok, so that’s the end of my notes, with some commentary thrown in. Penny gave me a good deal of food for thought. She is doula #1 and she has a vast amount of experience, information and love to share. One day, I will find time to take a training from her directly.
Sat Nam.
Leave a Reply